This presentation reports on research conducted within a large teaching hospital, which explores and expands upon the definition, presentation and context of suffering experienced by the patient at the end of life situated in acute care, viewed from the perspective of the nurses supporting them. Using a symbolic interactionist approach within a grounded theory methodology, 27 in-depth, open interviews with nurses working across multiple acute specialities were coded and analysed, in order to find and articulate the act of discernment – how nurses identify patient suffering. This progresses to a deeper analysis and understanding of the multiple factors which enable or inhibit the nurses' ability to respond to suffering. These factors are explored to reveal a complex relationship between the human condition of caring, the experience of compassion, of cultural norms and pressures, the expectations upon staff and the healthcare roles they adopt; the phenomenon of suffering and how the acute care environment influences both the patient’s experience and the nurse’s response is explored and evaluated.
This leads to a discourse on the contemporary social constructs of dying, including the post-modern framework of religiosity, spirituality, beliefs and practices around death and their place in a secularised and multicultural paradigm. The place of dying is reviewed from both an historical and gender perspective, with complex paradoxes identified, including death denial alongside medical ownership of morbidity and mortality, emerging themes of healthcare standards and a social reclaiming of dying as part of the human spiritual experience.
We discover that there are barriers that may prevent a full nursing response to suffering, but that there are also strategies and approaches, both for the individual and the organisation, that might enable positive, active responses to counter multidimensional suffering within the competing treatment paradigm of acute care. While healthcare professionals are accustomed to attending to disease and its symptoms, it is found that suffering arises in the non-physical. We discover that the response to suffering is as complex as the suffering itself; it is invariably non-clinical and uniquely individual to the nurse, who acts with personal intent influenced by strong internal and external factors.